WHAT WORKS? A LITERATURE REVIEW OF THE EVIDENCE FOR THE
EFFECTIVENESS OF PARENTING STRATEGIES
Prepared for Child and Youth Health
by Pam Linke in June 2001
Updated October 2004
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CONTENTS
Introduction
Executive summary
Background
 current context for parenting
 risk and protective factors
 cost of risk factors
Rationale for parenting programs
 introduction
 research
 reports
Evaluated parenting programs
 introduction
 interventions that address risk and protective factors
 elements of programs that work
 cost effectiveness
Recommendations from the literature
Conclusion
References
Appendices
 program examples
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INTRODUCTION
This literature review has been undertaken to provide a basis for decision making about
Child and Youth Health services to parents. Apart from a few exceptions, which have
been noted in the text, it focuses on parenting interventions which have been rigorously
evaluated and have shown benefits in positive outcomes for children. There are many
other parenting programs which may also be effective, but have not met the standards of
evaluation so have been omitted. Because this study was undertaken for Child and Youth
Health purposes, it looks mainly at the health/socio-emotional aspects of parenting. This
means that to a large extent early literacy programs per se are excluded, although it is
acknowledged that there is evidence that these can have a positive impact on children's
development and this offers opportunities for Child and Youth Health to link with the
Department of Education, Training and Employment in partnerships to assist children’s
development. Many of the programs for parents covered in the report do have a specific
literacy component and all programs could be expected to have an impact on literacy
through focus on communication.
Wider areas where support for parents and parenting could be important have not been
considered in this paper because of the scope of the literature review. These could
include, for example, areas such as family friendly work practices, family friendly
communities, housing, child and family impact considerations on government and
community policies and practices.
In spite of the clear evidence of the disadvantages of children in this group I was unable
to find evaluations of successful programs for Aboriginal children.
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EXECUTIVE SUMMARY
This report highlights the fact that there are cost effective programs which can bring
about more positive outcomes for children who are at risk of social or emotional or
mental problems which inhibit their living skills, contribution to the community and
enjoyment of life both in childhood and ongoing into adulthood.
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Risk factors have been well documented by considerable international and cross
cultural research as have the factors which help to protect children against adverse
outcomes. Most protective factors for children can be addressed through
parenting.
The cost to the community of not addressing risk factors, particularly in the early
years, is very large in relation to the cost of intervention, however expenditure is
in the present and savings are in the future.
Parenting programs tend to have more cost benefits for the community when used
with parents who have more risk factors than for the general community.
Current research into the development of the brain as well as current and past
research into social, educational and mental outcomes for children highlights the
importance of a positive and supportive early environment - the environment
provided, usually, by parents.
Numerous national and international government reports support the importance
of programs for parents, especially in the early years but also at transition or crisis
points.
Programs that have been shown by rigorous evaluation to have potential to lead to
positive outcomes for children include: home visiting by professionals, parent
education groups, antenatal support and early childhood and parenting centres.
Other programs such as community development/social capital building have not
been rigorously evaluated in the same way but may have contextual benefits in
providing positive and supportive environments for families and children.
Social marketing can play a major role in community education and the raising of
community literacy about parenting and outcomes for children.
Elements that contribute to programs that work include careful design and
program planning and staff with both appropriate qualifications and personal
skills.
Programs such as home visiting, alone, are not as likely to be successful as
interventions which involve a raft of different options and resources for families,
eg selected services for particular needs within universal services.
A number of recommendations from this literature review have been highlighted
in the recommendations section of the report and offer considerable possibilities
for effective support for parents and children in South Australia.
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BACKGROUND
Glad to have you aboard……
For the next 18 years you will
be personally responsible for the
care and well-being of another
human being. You're on your own
Good Luck!
Popkin, 1986.
Current context for parenting
We live in an era and a culture where we know more about parenting and what works for
children than ever before, so there are huge windows of opportunity to make a real
difference. While it is clear that conditions for children have improved in many ways
over the past century there are still too many children who are not getting the start they
need to make the most of their lives.
There is probably more pressure on parenting than ever before. While the evidence
presented daily in the media about the importance of parents to outcomes for children can
be helpful, it also can be seen by parents as an added responsibility and pressure and
even, sometimes, blame. In spite of rhetoric about the importance of "the village" to raise
children, child rearing is largely seen in our community as a private responsibility of
parents unless it goes seriously wrong.
In all other parts of home management, technology has reduced the workload. In
parenting the opposite effect has been observed especially where both parents work
outside the home, so the time for the complex roles of parenting has been eroded. At the
same time many of the traditional structures to support parenting are also being eroded structures like clear marriage expectations and parenting roles, and support networks such
as families, extended families, communities and villages. While many of these changes
offer new opportunities to parents - employment all over the world, opportunities to leave
dysfunctional relationships and much more choice for women, adequate new supports for
the parenting function of adults have often not been put into place.
In South Australia in 1998 18% of children lived in a family with neither parent
employed, and more than 25% in families where no male was employed. The number of
sole parent families in South Australia is growing, including sole parent families where
the head of the family is unemployed. In the 1996 census 45.6% of all children in
Adelaide were living in families receiving income support. The South Australian Child
Health Council (1999) noted that "increasing numbers of children in South Australia face
socioeconomic and other forms of disadvantage, resulting in significant adverse effects
on their health and well-being…particularly in the case of many indigenous children."
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As a society we give lip service to the value of children, but services and resources have
not followed the rhetoric, especially for young children. There is an assumption that flies
in the face of consistent evidence that young children are "resilient" so that what they
require for optimum development can be easily overlooked. [The concept of resilience is
discussed later].
Programs for parents are still largely focused on treatment. In Western societies, where
parenting is considered a private rather than community responsibility, this can lead to
difficulties in parents asking for and accepting help. This is exacerbated by increasing
knowledge about child development and higher expectations of parents, both personal
and from the community.
Some of the current issues for parents and parenting as identified by parents include:
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poverty
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family break-up; including residence and access issues after separation
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isolation
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living and working away from family supports
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step family parenting
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isolation of parents from their cultures of child rearing
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community values and confusion about the importance of childrearing
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quality of out of home care for young children.(Hogg et al, 2000)
Note: in parts of this report the term early intervention is used. In the context of the paper
this implies early intervention with parenting. The term mental health as used in this
report indicates the literal meaning of mental and emotional well-being, not as is often
inferred, mental illness.
Risk and protective factors
Resilience
In discussing programs for parents and children it is important to view them in relation to
the risk factors they are intended to address, and the protective factors they are working
to develop. Often these factors are seen in the context of the development of resilience in
children. Resilience may be defined as the ability to cope with the challenges of growing
up and living in the adult world without major disruptions such as criminal convictions or
mental illness. Resilience is always defined in relation to risk factors - usually risk for
mental illness, criminality or drug dependence. [Resilience is never absolute, and studies
of adults who have coped in the presence of risk factors have shown that there are still
some damaging effects from the risk factors, albeit not major life-disruptive ones
(Werner, 1992)]. There is always an imperative to try to remove the risk factors where
possible as well as to develop protective factors.
Risk and protective factors have been the subject of much research over many years and
results are remarkably consistent over time and culture (Linke, 1998). Protective factors
can be classified into three main areas, factors in the child eg temperament, factors in the
family eg positive attachment in the first year and factors in the environment eg a
supportive relationship with a school.
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Exactly how the protective factors work is not clear from the research but accumulated
risks lessens the possibility of children developing resilience (or coping skills) while
accumulated protective factors enhance this.
Risk factors
Some of the risk factors that are associated with juvenile delinquency and antisocial
behaviour in adolescence and adulthood include harsh or abusive discipline, parent
offending, being a victim of child abuse, need for special education, a family death or
family break-up and anti-social behaviour at a young age (Walker et al, 1998). Factors
that relate to the family and are therefore potentially amenable to parenting interventions
include harsh discipline, weak parental supervision, lack of positive discipline, lack of
parent involvement with the child, poor problem solving and negative family
communication (Patterson et al., 1992).
A recent report from the Australian Institute of Criminology (Bor, 2001) highlights the
"predictable developmental trajectory of behaviour problems beginning in childhood" for
antisocial behaviour in adolescence. They note that there is evidence of continuity
between aggressive, non-compliant behaviours measure between one and three years of
age and externalising behaviour problems at five years of age and a significant proportion
of the children (up to 50%) will experience similar problems into adolescence.
Webster-Stratton (1997) notes that risk factors that lead to continuation of problems into
adolescence include: beginning in the preschool years, problems in different settings eg
home and school, frequency and intensity of antisocial behaviour, having many different
antisocial behaviours and the presence of ADHD.
Risk factors for mental health problems and delinquency (Commonwealth of Aust. 2000)
and delinquency include:
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Prenatal brain damage
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Low birthweight (6.8% of children in South Australia*)
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Perinatal stress
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Physical and Intellectual disability (7.8% of children in South Australia*)
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Low intelligence
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Difficult temperament
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Having a teenage mother
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Having a single parent (70% of children in one parent families were in the lowest
40% of income distribution in 1996/7*)
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Absence of the father in childhood
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Large family size
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Long parental unemployment
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Mental illness in a parent
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Parental alcoholism
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Parental criminality
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Poor quality care in the first year of life, if both parents are working outside the
home
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Major separations in the early years
Family break-up especially where there is parental conflict. (21% of Australian
children with one natural parent living away from their home*)
*Children Australia: a social report (1999)
Risk factors are not necessarily causal and may be associations with other causal
problems rather than causal in themselves. It is important to note that risk is not destiny
and these factors are related to populations, not individuals.
Cost of risk factors
The cost to the community of the risk factors that parenting programs seek to address is
considerable.
 Over $2 billion is spent each year in Australia for mental health services (O'Hanlon,
2000). About 20% of people have some kind of mental health problem.
 The economic cost of child abuse to South Australia in 1995/6 was estimated at
$303.33 million.(McGurk, 1998)
 The cost of the criminal justice system to the South Australian community per annum
is approximately $300 per person ($450 million, pa.)
Appropriate early parenting interventions are associated with better outcomes for children
and less demand on services for all of the above areas.
From “Crime in Australia – Law enforcement resources”.
http://www.ncavac.gov.au/ncp/publications/crime/law_enforcement_resources.htm
Protective factors
Protective Factors (Linke, 1998) which mitigate against damaging outcomes from risk
include
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secure attachment
positive discipline
parental supervision (knowing where children are)
family support eg grandparent
a sense of achievement
being needed (required helpfulness)
external supports such as school
belonging to a supportive community group such as a church group
internal locus of control ( a sense of being able to impact on what happens to a
person).
It should be noted that most of the protective factors are related to parenting and
potentially can be impacted on by supporting parents.
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RATIONALE FOR PARENTING PROGRAMS
If we do not attend to the needs of children "we risk paying a terrible price in our
children's later behavior - drugs and anti social and violent acts…..our grandchildren
will live together in a society with the offspring of neglected families. So will yours."
(Brazelton, 2000)
Introduction
The evidence to support interventions for parents is overwhelming and comes from the
juvenile justice, mental health, physical health and more recently brain research spheres.
Much of this research has already been summarised in various government reports.
Research
Criminal justice
Wilson and Loury (1987) in a major investigation of juvenile crime in North America
found that "defiance, disrespect, class disturbance, aggression and disobedience in
kindergarten and year one as rated by teachers predicted a high rate of offending
behaviour in adolescence. They found that parent education programs produced the most
promising results when they targeted early behaviour problems. The majority of frequent
offenders rated as badly behaved in the first grade. While risk is not destiny this presents
an opportunity with high probability of making a positive impact not only on the lives of
individual children but also on the community both in cost and comfort!
Mental Health
The research of Lynne Murray (1997) into the outcomes for infants of untreated maternal
postnatal depression during the early months of the infant's life shows long term impact
on children's social, emotional and psychological health. The Commonwealth report
"Promotion, prevention and early intervention for mental health" (2000) recommends
interventions with parents as major strategies to promote mental health in Australia.
Brain Research
In major international reports Keating and Hertzman (1999), Marmot (1999), Shore
(2000), McCain and Mustard (1999) have stressed the importance of the now
incontrovertible evidence that the quality of environment and nurture in the early years
has far-reaching and important effects on health, social development and education and in
the end the productivity of the nation. McCain & Mustard (1999) in summing up the
evidence from research into early development of the brain conclude that "nurturing by
parents in the early years has a decisive and long-lasting impact on how people develop,
their capacity to learn, their behaviour and ability to regulate their emotions and their
risks for disease in later life; and (that) negative experiences in the early years, including
sever neglect of absence of appropriate stimulation, are likely to have decisive and
sustained effects…..What is fascinating about the new understanding of brain
development is what it tells us about how good nurturing creates the foundation of brain
development and what this foundation means for later stages of life". They identified
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parenting as a key factor in early child development for families at all socioeconomic
levels.
Reports
International
In response to the evidence of the importance of supporting parents governments in
developed countries are investing large amounts in programs for parents of infants and
young children.
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In response to the Acheson report into inequalities in health, the British
Government is investing more than £540 million into the Sure Start program for
supporting families.
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A National Commission on the Family Report in Ireland (Govt of Ireland, 1998)
recommends a national information strategy for parents, ranging from media
campaigns, a telephone helpline, printed information and parent education and
skills programs.
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A national report into school readiness in the US (Beth-Pierce) states that social and
emotional competence beginning in the first year is critical to early school success
and accomplishments in the work place.
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The Scottish Office Report, "A safer Scotland: tackling crime and its causes" has
identified the quality of family life as one of the most important factors in
explaining youth crime and has allocated £42 million over the next three years to
support parents and children in the 0-3 age range including parenting classes and
easier access to child guidance.
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The From Neurons to Neighborhoods report from the US Committee on Science
and Early Childhood Development give the following take home messages:
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Early experiences matter and early interventions can shift the odds, but the
focus on birth to three begins too late and ends too soon.
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Healthy early development depends on nurturing and dependable
relationships.
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How young children feel is as important as how they think, particularly with
regard to school readiness.
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Society is changing and the needs of young children are not being met.
And they assert that "at a time when scientific advances could be used to strengthen early
childhood policies and practices, knowledge is frequently dismissed or ignored and our
children are paying the price".
Australian Government Reports
Major government reports in Australia have concluded that prevention and early
intervention will save communities' and the Nation's resources both financial and
psychological.
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The Australian National Action Plan for Prevention and Early Intervention for
Mental Health recommends: workplace support for families, antenatal education to
promote mental health literacy for parents, identify the core effective mental health
components of home visiting and provide home visiting and parent support
programs…, develop and evaluate demonstration high quality child care programs,
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implement and coordinate screening programs for infant health and parent mental
health problems.
The Australian National Mental Health Strategy (Commonwealth of Aust, 2000)
presents a rationale for adopting a promotion, prevention and early intervention
approach to mental health, arguing that "accumulating evidence shows the
widespread and long-term benefits of this approach" (p xi) and includes as process
indicators "the presence of evidence based programs related to promotion,
prevention and early intervention for all priority groups ( p26).
Pathways to prevention: developmental and early intervention approaches to crime
in Australia. This report states "there are good reasons for intervening early in life.
Families with babies and preschoolers that are3 at risk of poverty, relationship
breakdown and abusive or inept parenting styles are more likely to produce
teenagers at risk of criminality and substance abuse….successful intervention at an
early age is a cost effective preventive strategy. This could be seen as a generic
form of early intervention". (p10)
Children and disadvantage: the South Australian picture: directions for action. This
report recommends "an investment in early emotional and educational development
in the first years of life and throughout childhood…and strategies that are inclusive
of the child's family, school and peer networks, neighbourhood, community and
culture, and target not only the child's behaviour, but also social and problem
solving skills, and social and environmental conditions".
Intervening early: opportunities to support young South Australian children and their
families. This draft report of the Child Health Council/Child Health Advisory
Committee of the Department of Human Services highlights the importance of
intervening in the early years in response to research that has “generated a deeper
appreciation of:
- the importance of early life experiences…
- the central role of early relationships…
- the capabilities, complex emotions and essential social skills that develop through the earliest years of life;
- and the opportunity to increase the odds of favourable developmental outcomes
through timely effective interventions and supportive community environments.
While the substance of this report is devoted to early intervention rather than parenting
per se, many of the examples of early intervention recommended are targeted to
parents eg home visiting programs, community based group education programs for
parents and early childhood development programs. The report also recommends a
universal combined with targeted approach.
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EVALUATED PARENTING PROGRAMS
Introduction
This section looks at programs which have been evaluated and show positive outcomes
for children. Except incidentally it does not cover outcomes for parents, although in many
programs these have been positive even where they are not the major program goals.
"High risk intervention, (preventive or therapeutic) is a clinical rather than an
epidemiological task (Fonagy, 1998). In looking at what works it is important to take into
account the way the programs are delivered. Similarly designed programs can have very
different outcomes depending on implementation and the risk factors being addressed.
Evaluation of a home visiting program for LBW infants where home visits over two years
were accompanied by parent group meetings and educational programs in specially
designed preschools showed no significant health or behaviour effects in the long term
(Bradley et al 1994). Other programs have shown sustained beneficial effects
(Kowalenko, 2000; Murray and Cooper, 1997) both on prevention of pre-term deliveries,
less child abuse, cognitive and social outcomes for children. This highlights the
importance of program design and staff training - of how interventions are implemented
as well as what is done.
Criteria for effective prevention and early intervention parenting programs include:
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An empirically based and tested model of the aetiology of the problem which
identifies risk and protective factors
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A reliable and valid method of identifying children at risk
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Effective methods for reducing risk and enhancing protective factors
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The opportunity to apply these methods in practice (Kosky et al, 200, p11)
These criteria have been met by research into many issues including anxiety, resilience,
delinquency, and antisocial behaviour.
A number of well designed delinquency prevention programs based on knowledge of risk
factors have been shown to be effective, the most important parent-related programs
being:
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Intensive home visiting
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Parenting skills education
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Pre-school intellectual enrichment programs (Farrington, 1996)
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Interventions that address risk and protective factors
The following interventions have been identified as successful in addressing some risk
general and some particular factors.
Home Visiting
Programs that enhance attachment between parent and child in the first year of life have
been shown to have sustained positive outcomes for social and cognitive development.
Early positive attachment is an important component of resilience. Fonagy (1998) notes
that mothers who have positive ante natal attachment scores have children who have
more secure attachments into childhood. Evidence shows that early intervention for
parents of infants with difficult temperament can be effective in modifying attachment
over time.
Well designed and delivered early home visiting programs are one of the interventions
which have been shown to be cost effective over time. The effective programs are
intensive in the early months, linked to other resources where appropriate, delivered by
professionals, sustained over the first two years, have strategies clearly linked to risk
factors and expected outcomes, and have well trained and mentored staff. (Behrman,
1999). One such program in Australia (Armstrong, 2000) is showing promise in early
evaluations.
It is also important to note that many home visiting programs have important effects on
the parents as well as for the children, eg in spacing out further children, better entry to
education and the work force and less dependence on welfare payments (Kitzman, 2000).
Home visiting programs by volunteers have not been shown to have the same sustained
positive outcomes but may be a helpful part of a raft of interventions in providing social
support for parents and helping to build community.
Parent Education/training
In Australia, currently most programs for parents are run by women (Allen, 1994) and
most are run for middle class groups although the latter is changing with more being run
across class and culture. A significant number are being run for parents from Southern
Europe.
There is general acceptance that many parent education programs are effective in
improving parenting skills, parent child relations and children's behaviour however there
are comparatively few rigorous evaluations.
Some which have been evaluated include the following.
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Follow up studies for programs for parents of children with ADHD show a
sustained improvement in oppositional behaviour but effects on ADHD symptoms
are equivocal (Kosky, 2000)
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A recent review of group based parent education programs for children with
behaviour problems (Barlow, 2000) found considerable heterogeneity in the
programs studied. Most of the programs did not meet the evaluation criteria to be
included, however of those that did the results showed that "structured parent
education programs can be effective in producing positive change in both parental
perceptions and objective measures of children's behaviour and that these changes
are maintained over time."
Antenatal
Antenatal classes focused on psychological issues regarding childbirth, support and
parenting have shown positive effects on emotional adjustment, mood and parenting
satisfaction. (Kowalenko, 2000). Home visits during pregnancy have been shown to lead
to teenage mothers having heavier babies, less smoking in mothers, and fewer pre-term
deliveries; thus directly impacting on risk factors. (Farrington, 1994)
Postnatal parenting groups
Post natal parenting groups using a mental health model have shown positive effects on
parental responsiveness to the infants and parenting skills. (Kowalenko, 2000)
Preschool/early years
Parent education programs for parents whose children are difficult to manage or
aggressive have been shown to produce ongoing positive outcomes. While, for many
children these behaviours decrease with age, there is a significant proportion who go on
to adolescent antisocial behaviour making this an important area for intervention.
(Farrington, 1994; Wilson and Loury, 1987).
School age
Barlow & Stewart-Brown (1998) in a review of school age programs for children with
behaviour problems (not ADHD) including temper tantrums, aggression and non
compliance found the "structured parent education programs can be effective in
producing positive change in both parental perceptions and objective measures of
children's behaviour and these changes are maintained over time."
Social capital building
The evidence for volunteer programs that provide parents with support and/or home help
shows that such programs are valued by parents but do not have an impact on outcomes
for children or reduce the risks of abuse (Carr, 2000). However they may have an
adjunctive role eg in providing supportive environments for families, and more
systematic evaluation is needed to support this. The Australian National Mental Health
Strategy sees the building of supportive environments as a goal of early intervention.
Parents of adolescents
More research is needed into whether there are effective treatments for adolescents.
Group programs for adolescents with conduct problems outside the family system can
make them worse (Carr, 2000) because of the peer group learning effect. Generally
15
programs for parents of adolescents with conduct problems do not seem to be effective in
terms of behaviour change for the adolescents and the evidence for "early determinants of
adolescent behaviour" is strong (Toumbourou, 1997).
However part of the reason for the lack of evidence for programs for parents of
adolescents may be due to the lack of proper evaluation. There are some well evaluated
programs for parents of adolescents which have been shown to have positive effects (eg
Litrownik et al, 2000, Henricson et al., 2000). The program for parents (PfP) project is an
Australian National Project funded by the Department of Health and Aged care and has
been piloted across Australian with culturally diverse communities including NESB and
Aboriginal families, and independently evaluated. Parents and young people surveyed
after the program reported positive effects on parent well being and confidence, parentadolescent conflict and adolescent depression, antisocial behaviour and self harming
behaviours.
There are a number of reasons why there is potential for piloting and exploring models
for effective intervention with parents of young people.
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Adolescence is a time of transition where parents and young people are coping with
changed expectations and demands.
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Resiliency literature support the relevance of ongoing family support within the
context of appropriate differentiation for positive outcomes for young people.
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Parents have a strong psychological influence on through the adolescent years.
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With changing community structures and later moves to independent living there
are both pressures on and opportunities for parents of young people to have a
positive influence.
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Adolescent risk taking behaviours eg drug use, bring about family crises and hence
openness to change.
The number of programs offered to parents of older children and adolescents is minimal
compared with those offered for the early years, and yet there are many families with
major parenting and relationship difficulties in these years.
Programs for parents which keep help to family networks intact over the transition to
adolescence have the potential to be effective as research shows that continued family
attachment is a protective factor in resilience (Werner, 1994)however there is little
research into programs that are addressed to parents of children in early adolescence.
Early Childhood and Parenting Centres
There are not many evidence based evaluations of these but the model has been supported
by both clinical and political leaders in North America, Europe and Australia. Many of
these centres are currently being trialed and offer the opportunity to provide welcoming
local bases for parents to get a raft of services including home visiting, child care,
continuing education for parents, early literacy and parenting skills learning. They also
offer a structure for interagency collaboration and for piloting and reviewing new
programs and training professionals. The Chicago Child Parent Centres (Reynolds, 2001)
a large scale program developed on this model are showing promising results. The model
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provides educational and family support services to children aged 3 to 9 years. They are
located in the poorest neighbourhoods in Chicago. It includes special learning activities
for children, and parenting and personal resources for parents including home visits,
resource mobilisation, educational workshops, health and nutrition services, health
screening, speech therapy, nursing and meal services. At age 20 years there were less
school dropouts than the control group, and significantly lower juvenile arrests.
Universal Programs
Universal programs are few and usually limited to the provision of information, parent
helplines and child health checks and preparatory development information. Reviews of
the efficacy of these are limited. They are generally are part of a raft of programs that
parents seek.
Social marketing/health promotion.
While it is harder to find evidence based assessment of the impact of social marketing on
developmental outcomes for children there is evidence of successful public education
campaigns regarding health, eg immunisation media campaigns. The media influences
social attitudes and can play a major role in community education (Mental Health
Strategy).Brazelton and Greenspan (2000)highlight the importance of public education in
developmental literacy.
The US Surgeon General's conference Report on Children's Mental Health (Olin, ed,
2001) recommends community awareness strategies regarding the needs of children.
Universal Information Provision
Evidence that many parents turn to the Internet for information about parenting and
children's health is growing, however evaluations of the efficacy of this as a method of
support for parents is not available at this time. In general information provision through
the world wide web as part of a universal approach to supporting parents and families
should have benefits in being available at all times and empowering parents in their
parenting role and interaction with professionals.
Specific issue - conduct disorder
Early parenting interventions for conduct disorder with the most supporting evidence
(Davis, 2000, Wilson & Loury, 1987, Sanders, 2000) are those which assist
parents/carers in providing "effective, non coercive discipline, support for children's
prosocial behaviour and achievements and effective family communication and problem
solving styles". Davis notes (p72) that there is less evidence of success with teenagers
with conduct disorders and relatively little success "without the use of family
interventions". Sanders (2000) cites evidence "for the efficacy of parent training" with
early adolescents with "oppositional behaviour problems".
Specific issue - Aboriginal communities
Reduced parenting skills are amongst the effects of removing Aboriginal and Torres
Strait Islander children from their families, often depriving children of the experience of
exposure to family life and parenting. There are no clearly evaluated parenting programs
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for Aboriginal and Torres Strait Islander parents, however the Resourceful Adolescent
Program for Parents (RAP-P) which is being developed in North Queensland will be
evaluated.(Clarke, 1998). Indigenous children represent 4% of all children in Australia
and the number is increasing (Trewin, 1999).
Elements of programs that work
Effective early intervention programs should be designed to divert pathways and produce
long-term effects (Pathways p157) and should be "guided by an understanding of the risk
and protective factors of particular groups". The Pathways to Prevention report also
stresses that they should be "rigorously evaluated" and demonstrate that prevention does
work. The following are common elements of effective programs.
General factors

Clear goals and strategies are essential to effective programs, with selection of
appropriate models related to the target group.

Programs that start early in a child's life have the highest chance of success.

A relationship based approach is an essential component of successful prevention.

Programs which enhance parent-child communication, strengthen parent sensitivity
to the child's cues and improve parent-child relationships have shown significant
improvement on long term follow-up in children's and young people's conduct.

Successful programs are community based.

Programs should attend to both parents' needs and parenting.

Some local investment in planning and resources and selection of evaluation
criteria is important.

There needs to be provision of materials for parents who cannot afford them.

Personal qualities of the leader/clinician are consistently shown as important responsiveness, participation, ability to relate to the knowledge base of parents ie
the process of care is important to maintain families; and personal qualities are
important as well as qualifications.

Strategies which allow for working both with parents and children eg some
program components addressed directly to the children appear to have a better
chance of bringing about positive outcomes for children.(Behrman, 1999)
Home visiting

No single service strategy serves the needs of all families and a range of services is
needed eg including family support, parent education and enriched environments
(provided either by in-home programs or individualised child care) for infants.

Programs that go for at least two years have the most chance of success.

Focus should be on the meaning of the infants' behaviour for the caregiver, and on
the listening to and responding to infants' communication cues.
Parent education

Focus on age appropriate social skills training.

Trained leaders for parenting groups.
18

Programs which provide training to both children and parents, but not both together
have been shown to be effective.. (Webster- Stratton, 1997)
Cost effectiveness data
"In God we trust, from everybody else we demand outcome data" (Fonagy, 1998).
Very few programs have been evaluated for cost effectiveness over the long term and
there is a need for more evaluations such as the following.

The Perry preschool program and the Elmira program have both been shown to
have significant cost savings over the years, (Karoly et al, 1998). There is an added
benefit to the community of more of the children becoming wage earners and
contributing to the economy.
Reprinted with the permission of The David and Lucile Packard Foundation.

The evaluation of The Perry preschool program showed that for every dollar
invested there had been a long term saving in real terms of $7 in welfare benefits,
crime and remedial education. [If $12 million were spent on a program in 2,001-2,
providing a similar service for about 2,700 children, there would be a savings
across government of $84 million dollars. If the program was continued each year
$84 million would be saved in the future for each annual cohort of children (over 5
cohorts of children = $420 million) – a result of very substantial savings (net $340
million per 5 year cohort) in criminal justice, mental health, welfare benefits and
most important the health and well being of the children involved.]

Two and a half years of pre and postnatal home visiting by child health nurses of
poor single mothers showed savings that were five times higher than program costs
[for mothers without risk factors, benefits were less than program costs]. (Karoly et
al, 1998).
19
All amounts are in 1996 US
dollars and are the net present
value of amounts over time
where future values are
discounted to the birth of the
participating child, using a 4
percent annual real discount
rate.

Source: Lynn a. Karoly et al.,
Investing in our children: what
we know and don't know about the
costs and benefits of early
childhood interventions, Rand/Mr898, Santa Monica, CA: Rand,
1998. Copyright RAND 1998.
Reprinted by permission
"While the health system might arguably be the best 'home' for nurse home visiting
the savings are across government: welfare, criminal justice, tax increase from
future earned income, thus a whole of government perspective is needed to justify
costs" (Ibid).
While it is important to be aware that no programs are effective for all children, it is clear
that for some programs there is significant overall cost saving to the community as well
as benefits to the families involved.
Note: Only portions of such programs can be evaluated for cost effectiveness. Other
benefits such as personal benefits to the families, higher IQ, better parent-child relations
and potential for better parenting in the next generation could also be considered.
20
RECOMMENDATIONS FROM THE LITERATURE
1. Most programs are aimed at treatment and more attention should be given to
prevention, although accessible early treatment options are important.
2. The David and Lucile Packard Foundation's review of home visiting programs
(Behrman, 1999) recommends that "existing home visiting programs should focus on
efforts to enhance implementation and the quality of their services and that home
visiting should not be relied on as the sole service strategy for families with young
children". Home visiting is not enough on its own but should be used with a raft of
programs tailored to need eg groups, counselling, early literacy etc. The most
effective interventions generally seem to be those which offer combinations of
methods across different contexts.
3. Programs such as professional home visiting in the first two years which are effective
for "at risk" families are not cost effective for the general population. In order to make
most effective use of resources a targeted approach to intensive home visiting should
be taken.
4. That a range of programs be developed - responsive within a universal framework.
Targeted within universal could be one way of reducing stigmatisation [there are few
universal parenting programs, most are targeted - universal programs are usually early
health checks and developmental information]. Consideration must be given to the
balance and rationale for universal compared with targeted.(Kosky, 2000,p9), taking
account of the potential impact of labeling (Wilson, 1987).
5. Even with programs which have been shown to be effective there is some attrition
and more research should be done into which families do not stay with programs and
why. In some of the most successful programs (Olds et al, 1986), about 20% of
parents refused to take part and many of these were those in greatest need. It is
obviously important to present programs in a way that is as inclusive as possible and
to evaluate and document where this is successful.
6. Implementation is fundamental especially training and support for staff (O'Hanlon,
2000 ). There is "increasing recognition that the success of interventions of this nature
(home visiting) depends on the capacity of the person providing the service to develop
a trusting and respectful relationship with the mother (parent)." (Stewart-Brown, 2000
). Some of the skills identified as needed for all home visitors by Gross et al (2000)
(p31) include:

observing: attention to cues, especially non verbal and environmental

listening: attending to and correctly interpreting messages

questioning: to obtain information, verify facts and feelings, facilitate
expression of problems and help focus

probing: seeking additional information about a problem, behavior or
feelings

prompting: facilitating particular responses by encouragement

supporting: encouraging, giving feedback and praise.
21
7. Being able to standardise quality of programs across service delivery centres is
important to success.
8. Programs should be sustainable and not end abruptly but with planned transitions to
appropriate community resources.
9. Although qualifications are important the personal qualities and life experience of
service providers should also be considered. (Olds, 1988)
10. Zero to Three, the US early development specialist organisation, recommends
training of multidisciplinary teams of development specialists including nurses,
teachers and social workers to work with parents of infants and young children.
(Kaplan-Sanoff, 2000). They also support the concept of infant mental health
specialists , multidisciplinary teams with special training in early development and
relationships (Weatherston, 2000)
11. More research is needed to support which are the best program designs, which can be
effectively generalised, how to best target programs and whether the pilot/selected
programs will be effective on a large scale (Karoly, 1998).
12. Davis (2000, p47) highlights the fact that programs should be built on well articulated
and evidence based theory of risk, resilience and outcome; the need for program
procedures and methods to be stated as explicitly as possible so the programs can be
repeated by others; and the need for programs to be monitored and evaluated. She also
recommends

"standardised but not restrictive service activities, delivery and principles

the modification and expansion of the role of staff and service providers from
traditional roles

the existence of planned immediacy between training, research, evaluation and
service

a direct service focus within a conceptual understanding of a continuum of
care…"
13. Brazelton & Greenspan (2000) recommend the consideration of partnerships with big
business to set up child parent centres offering preventive health care, child care and
parent support on site which employ large numbers of people.
14. Sanders (2000) notes an "increasing emphasis on a public health perspective to child
mental health problems, which stresses the importance of developing cost effective
prevention initiatives targeting entire populations…"; the importance of the concept
of levels of intervention according to need and a "developmental perspective which
seeks to identify key transition points in the family life cycle which may constitute
periods of greater receptivity to intervention".
15. Because the "at risk" approach, while effective, also includes some children who
would cope without intervention the assessment of families for targeted services is an
important component of intervention.
16. Because of the evidence that conduct disorder and delinquency is a significant cost to
the community, can often be predicted at a young age and is resistant to treatment in
adolescence and older (Fonagy, 1998), and that early intervention can be successful
22
programs to assist parents in managing children's early aggression and behaviour
problems should be a priority preventive intervention.
17. While there are enough properly run evaluations of parenting interventions to support
the efficacy and value of the some programs, many programs which could be valuable
have not been adequately evaluated. The need to evaluate in order to find out what
works and for whom cannot be overstressed and should be part of any new parenting
programs.
 Research and evaluation of programs is fundamental especially aspects on which
there is not yet enough information such as the optimal intensity and duration of
programs, which families benefit and which aspects of which models are most
effective. In the best programs, some parents drop out, some families do not seem
to benefit and research is needed into these areas.
 Programs need to be evaluated against clear goals. The Australian National
Mental Health Strategy (2000) outlines outcome and process indicators for
interventions for mental health and the Pathways to Prevention report (1998)
indicates process goals for interventions for crime prevention together with
evaluation strategies.
Note: Guidelines for evaluating parenting programs for context, content, process and
product are outlined in a recent article in Family Relations (Matthews, 2001)
23
CONCLUSION
It is clear from all the evidence that intervening in the early years where there are risks of
child abuse, antisocial behaviour and mental illness is the most cost effective and
successful way to prevent major costs to both the individual and the community. Risk
factors are readily identifiable (Werner, 1994, Linke, 1998) as are protective factors.
[Note: intervening in the early years almost always involves parenting so that in many
ways early intervention and support/education for parents are synonymous.]
Parent education programs in the early and primary school years, multifaceted programs
and professional home visiting programs have all clearly been shown to provide positive
and cost effective outcomes. Other measures such as social capital building through
volunteer programs and programs for parents of adolescents have not such clear evidence
of efficacy however this may be because of lack of reliable evaluations and research into
these initiatives.
The varying success of programs and interventions highlights the importance of careful
planning, goal setting and program design.
While it is clear from the evidence that children with risk factors such as poverty can be
effectively assisted, the studies involved have usually been pilot programs or programs
run in a particular area. I was able to find no studies where a comprehensive statewide
planned approach to parenting, based on the evidence has been carried out and evaluated.
Obviously if this could be done it would be a major step forward in improving children's
health and development and in providing for safe and healthy futures for communities.
Timing is important in terms of intervention eg:

Infancy for protective interventions

Preschool and early childhood for preventive programs for anti social behaviour

Transition points such as divorce, stepfamily formation, toddlerhood, adolescence,
immigration, children with a parent in prison. (Rutter, 1985)
While there are many model projects being run in different parts of Australia and for
different periods of time (Davis, 1998), lack of proper evaluation and lack of
predictability of funding (Ibid) is a major concern. The large majority of programs are
selective, very few universal. In choosing interventions consideration needs to be given to
the prevalence and seriousness of the problem, the efficacy of interventions and
sustainability.
The research presented in this review supports the importance of programs for parents
which address protective factors for children in terms of outcomes for children, parents
and the community. These should be delivered within the context of the obligation of
government to provide appropriate information and support for all parents. Community
24
efforts to eliminate risk factors should not be forgotten. Eliminating the risk, where
possible, should be the first step.
RESEARCH UPDATE 2004
The following section comprises an update from selected research papers not
available when the original What Works was written (2001). In general they confirm
the content of the original report but there is some added value from the new papers.
While the following interventions have been evaluated to show effectiveness there are
broader public health initiatives which have also been shown to be effective which are
not considered here. These include improved nutrition, improved housing, improved
access to education, strengthening community networks and community wide
education to reduce substance abuse (WHO, 2004).
Child Parent Centres
Further evidence has been presented on the effectiveness of the Chicago Child Parent
Centres (Reynolds, 2004). Reynolds notes that the long term effects of the early
childhood interventions were traceable to school support, cognitive/educational
experiences and family support experiences. School commitment also contributed to
lower delinquency. Each CPC has a staffed resource room coordinating activities, an
outreach program and parent involvement in early education activities (from age 3).
Parenting Group Programs.
Group programs for parents can be effective and very suitable for enhancing
parenting skills and sustainable child outcomes even with high risk
families.(Puckering, 2004).
Home visiting - Evidence
Again the importance of rigorous evidence is highlighted before initiating costly
programs which may not be effective, Chaffin (2004). Chaffin notes that while the
prevention literature is full of studies supporting program effectiveness very few meet
criteria for evidence-based interventions. “Non-randomized designs are particularly
vulnerable to overestimating the size of intervention effects”. Many studies show only
immediate rather than sustainable effects. The notable exception to these criticisms is
the Elmira nurse home visiting model (Olds et al,. 1998). The Elmira study has been
taken as evidence that home visiting in general is a proven prevention method
(Chaffin, 2004) but Olds’ further research (Olds et al., 2002, 2003) shows that
paraprofessional home visiting programs do not provide the same positive outcomes
for children.
Chaffin further recommends that where evaluated programs are replicated or
generalised they are rigorously evaluated on an ongoing basis.
Parents who do not receive at least a minimum number of visits are less likely to have
significant improvement through home visiting programs. Retention is more likely if
home visitor is able to build a strong and respectful relationship with the client.
(Daro, 2003)
25
In an evaluation of Hawaii’s Early Start Program, Duggan (2004) found that program
impact was compromised not only deficiencies in implementation but also drift in the
model itself in taking the model to scale, while turnover in administrators and
program directors led to a gradual shift in program perspective – moving from a risk
reduction focus to a strengths based model. This compromised staff ability to work
with families to identify and address risks. Duggan’s study suggests that ambiguity in
the program model and challenges to implementation reduce the probability of
positive outcomes.
In the Early Start program (Daro, 2003) programs which used a combination of
professionals and paraprofessionals and provided them with regular supervision had
the greatest success. She also found that the initial relationship made with the home
visitor is crucial to enrolling in and maintaining the home visiting program.
A review of the impact of fathers involvement in Hawaii’s Health Start Program
(Duggan, 2004) found no impact on fathers and varying impact on families. In
families with non violent fathers the greater involvement of fathers seemed beneficial
because it was accompanied by greater maternal satisfaction. Promoting of more
involvement of violent fathers in couples who had previously not seen each other
often was not positive because the greater involvement was not accompanied by a
decrease in violence. More research is needed in this area. The study noted that home
visitors also felt less competent to work with fathers.
Home visiting programs for teenage mothers were investigated by Julie Quinliven
(2003). She highlights the difference between 18-19 year old mothers and under 18
year old mothers who have the greatest risks of child abuse, neglect and subsequent
pregnancies. A trial program for teenage mothers, not including under 18s and by
paraprofessionals showed now significant outcomes for the intervention group.
(Morell et al quoted in Quinliven, 2003). Quinliven’s own study shows that a nurse
home visiting program for under 18 year old teenage mothers can result in reduction
of adverse neonatal outcomes at least in the short term. Repeat teenage pregnancy
within a year was reduced from 13% to 3%. This is supported by UK studies quoted
in her paper.
Implications for home visiting program design and implementation.
 Several papers made the point that home visiting per se is not the intervention
but the context for a specific intervention. The context does not specify the
intervention nor the outcome. (McNaughton, 2004). The home visit provides a
facilitating context for the intervention but it is the intervention and the
relationship with the home visitor which leads to the outcome.
 Risk factors such as family violence, substance abuse and parental depression
present major challenges to home visiting programs. Often these are the areas
that home visitors feel least equipped to address. This finding is consistent
with home visitors’ self assessment. Furthermore home visitors are less likely
to recognise the risk factors that they are less equipped to manage. (Chaffin,
2004, Duggan, 2004). Chaffin also notes that domestic violence may be a
problem that home visitors, even trained nurses, find difficult to manage.
26








Adding a cognitive therapy component showed dramatic effect in the Healthy
Start home visiting program, suggesting that this is a worthwhile component
of program content. (Bugental et al in Chaffin, 2004).
Risk relevant intervention targets are important. Interventions should address
protective factors While empowerment philosophy brings valuable elements
to programs such as development of collaborative partnerships and positive
motivation, prevention interventions should be guided by known risk and
protective factors. (Chaffin, 2004, Duggan, 2004).
Effective home visiting programs have a well-defined and documented
program protocol and curriculum that allows flexibility to individualize
activities to respond to particular client needs.
Programs need to have a strong theoretical foundation, as well as be perceived
as relevant by the community they serve. (Thompson et al, 2001, Duggan,
2004). Developmental/pedagogical interventions are likely to have more
impact on children’s social competence and adaptation while interactional
methods have more effect on maternal responsiveness. Empowerment
strategies are more effective in engaging “at-risk” families. Interventions that
work with both parent and child have the best outcomes. (Barnes, 2003).
Although it is important to have only one primary home visitor, establishing
multi-disciplinary teas can bring the full resources of a program to families
through case consultation and supervision. Thompson maintains that training
and supervision are critical for quality in home visiting services. (Thompson
et al, 2001)
Home visiting programs cannot operate in isolation and need to be integrated
with other health and community programs. These should include some centre
based programs where children spend time in direct activities related to
developmental outcomes. (Thompson et al, 2001)
Daro (2003) found that for the programs evaluated better outcomes were
obtained by moderate levels of supervision (reflective consultation) for direct
service staff than higher (more than once a fortnight) or lower (less than once
a month) levels.
Duggan (2004) notes that where more than one home visitor works with a
family eg male with fathers or cultural consultant there needs to be a clear
overall plan and policies and procedures for sharing information, monitoring
progress, and changing the plan as families reach individual or family goals.
The World Health Organisation (2004) summarises the main features of effective
programs as follows:
 There is evidence that the program is effective
 Consumers/funders/decision makers were involved in its development
 The host organisation provides real or in-kind support from the outset
 The potential to generate additional funds is high
 The host organisation is mature (stable, resourceful)
 The program and host organisation have compatible missions
 The program is not a separate unit but rather its policies, procedures and
responsibilities are integrated into the organisation
27






Someone in authority, other than the program director, is a champion of the
program at high levels.
The program has few “rival providers” who would benefit from the program
discontinuing
The host organisation has a history of innovation
The value and mission of the program fit in well with the broader community
The program has community champions who would decry its discontinuing.
Other organisations are copying the innovations of the program.
“In our formal evaluation of Washington’s effort at implementing research-proven
programs for juvenile offenders, one important lesson was learned. The programs work
and they produce more benefits than costs – but only when implemented rigorously with
close attention to quality control and adherence to the original design of the program.
Without quality control, the programs do not work”. (Washington State Institute for
Public Policy, 2004).
28
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33
APPENDIX
Examples of some program outcomes
Name
Bristol child
development
Program
Time
Monthly for 1st
yr, ongoing
where needed
Control
Yes
Type of Program
Home visits for 1st baby.
Including handouts.
Results
73% found home visits v.
useful
40% found written material v.
useful
Adelaide
Children's
Hospital
Ongoing
Yes
TV health promotion
programs for parents in
waiting room
Experimental group had
sustained increase in
knowledge (lessened over
time)
Parenting
adolescents
(Reisch)
6 weeks,
weekly
Yes
Communication skills training
Children and
young teens, post
divorce (Carr)
6-24 sessions
over 6-16
weeks
Yes
Group prog. Including info.,
social skills, stress
management
Parents as
teachers
Ante natal or
birth - 3 yrs
<10 home
visits
2 yr program
for 4-5 yr olds
Yes
Parent ed. child dev.
Preparation for school.
Decrease in antisocial
behaviour with fathers and
young people, not mothers.
Higher satisfaction with family
system
Post tests after 1 yr - decrease
in behaviour probs, school
probs, increased self esteem,
better relationships
Small effect. 1month dev. For
10 visits. Better with case
management services as well
Yes
Home visits and groups for
parents with limited education
HIPPY (Home
instruction for
preschool
youngsters
Comment
Mostly used in
deprived areas, if
not universal
parents can feel
singled out.
?Options for other
waiting rooms eg
health clinics.
?impact of
knowledge on
practice and skill
Sample not extreme
eg not in therapy or
violent conflict
Prog for non
custodial fathers
could add value
Inconclusive
34
Name
Healthy Families
America
Time
Control
Type of program
Programs vary
Results
Improved parent child
interaction. Mixed success
with abuse, health status.
Queensland
Home visiting
program
Weekly for
6wks, monthly
to 3 months,
up to 6 months
post partum
Yes
Less abuse, less smoking,
more parental confidence,
better attachment
Elmira Program
(NHVP)
From 29 wks
pregnancy to
2nd birthday
7 home visits
pre birth, 26
home visits 
2nd birthday
Yes
Healthy Start
2 years
-
Child health nurse home
visiting program for English
speaking families with a new
baby. Relationship building,
anticipatory guidance,
supported by SW and
Paediatrician
First parents with 2
sociodemographic risk factors,
<12 yrs education eg
unmarried, unemployed
Child health nurse home visits
with detailed guidelines, goal
setting for the woman as well
as parenting intervention
Statewide home visiting
program
Infant Health
Development
Prog
< 3 years
Yes
Home visits 1st year
Child dev centre years 1-3 +
parenting groups
Head Start
3-5 yrs
Yes
1/2 day academic program for
one preschool year for
children in poverty. Health
and nutrition services. Adult
ed. for parents and family
support services.
Positive effects on behaviour
and IQ at age 3. Decrease over
time. (lack of effect on VLBW
1500gm and IQ<70)
Positive effects on school
readiness, weak evidence for
long term effectiveness.
Comments
Recommend State
or Nationwide
context in which
support for all new
parents is the norm.
Benefits the neediest families,
little benefti for broader popn.
 reduced child abuse, fewer
arrests and convictions at 15,
smoked and drank less, fewer
sex partners, less child abuse.
Nurses the key.
Use for neediest
families. Important
to stick to the model
for research.
Improved parenting, less
abuse, more positive discipline
Needs comparison
groups.
Implementation
should be
monitored.
35
Name
Abecedarian
Project
Perry Preschool
Project
Time
0-5 yrs
Year round all
day
educational
childcare/presc
hool prgram
2 yr
intervention x
2 ½ hrs per
day 5 days a
week, 7
months of yr
Control
Yes
Yes
Chicago Child
Parent Centres
Yale Child
Welfare Project
Pregnancy 2 ½ yrs
yes
School bullying
program, Norway
Primary school
- 2 yr program
No
Syracuse Family
Development
Research
Program
5 yrs,
pregnancy on
yes
Type of Program
Program emphasises the
development of cognitive,
language and adaptive
behaviour skills. + nutritional
supplements and social
services as needed
Includes weekly home visits
by teachers, small classes,
specially trained teachers,
support and supervision for
staff
Results
Higher academic achievement.
Reduced need for special ed,
less dropout, less juvenile and
adult crime.
Focuses on child's total
environment and for some
groups continues for 6 years.
Neighbourhood centres
providing health, education,
parent involvement.
Gains in school achievement
depending on number of years
in program
Home visits focused on
current concerns, assistance in
achieving long term goals and
liaison to support services.
Paediatric care and
anticipatory guidance. High
quality day care.
Mothers achieved higher
education, smaller families,
almost all became
economically independent,
male children better adjusted
(teacher rating), project
children better achievement,
less absenteeism, better
behaviour.
After 2 yrs, 50% less bullying,
also less antisocial behaviour,
better attitude to school
80% reduction in crime
Less serious crime
better school grades
Higher self esteem and better
parent-child relationships
All children in schools grades
1-9, child training, parent info,
staff training
Home visits from pregnancy
on, weekly. Assist with parent
child interactions and referral.
High quality individualised
child care for 5 year..
Comments
Longer involvement
associated with
better outcomes.
By age 27 better jobs, fewer
arrests, lower likely hood of
receiving public assistance
Because there are no
overall specific
standards between
centres, some show
substantial
achievements, some
show none.
Progam also had a
positive effect on
siblings.
Note: this was a
very small sample
so generalisation
would be difficult.
36
Name
FAST track
Seattle Social
development
program
Montreal
Prevention
Project
Time
Grades 1-6,
most intensive
at transitions
eg Starting
School`
Grades 1-7
primary school
Control
Yes
2 yrs, early
primary age
Yes
Yes
Type of program
Learning programs including
tutoring and anger control and
social skills training at school.
Bi-weekly home visits, parent
training.
Parent ed groups, proactive
classroom management, social
skills training, home visits.
Multilevel intervention
Parent ed. Child training.
Focused on disruptive boys in
early primary school.
Results
Early evaluations show
improved behaviour, parenting
skills, less aggression.
Comments
Less alcohol and delinquency,
better family attachment and
communication, more
commitment to school
Lower delinquency and anti
social behaviour at age 12
37